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PCM III > GI Exam > Flashcards

GI Exam Flashcards

1
Q

visceral pain

A

hollow organs
-distension or stretching

comes and goes - crescendo decrescendo

not well localized

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2
Q

parietal pain

A

inflammation of peritoneum

steady aching pain well localized

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3
Q

right shoulder

A

gallbladder

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4
Q

left shoulder

A

spleen

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5
Q

back

A

pancreas/aorta

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6
Q

renal colic

A

renal system pain

flank pain

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7
Q

epigastric pain

A

MI**
peptic ulcer
acute cholecystitis
perforated esophagus

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8
Q

LLQ pain

A

sigmoid diverticulitis

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9
Q

melena

A

black tarry stool

above ligament of treitz

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10
Q

hematochezia

A

blood bright red

at level of colon or lower

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11
Q

cathartic

A

blood in stool

-makes you go to bathroom

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12
Q

blood outside stool

A

suggests anus

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13
Q

DDx for GI bleeding

A 
congenital - meckel
immune - UC, crohns, PUD
trauma - mallory weiss
neoplastic - zollinger-ellison
infectious 
metabolic - NSAID
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14
Q

red currant jelly stool

A

intussusception

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15
Q

jaundice

A

staining with bilirubin

pruritis - itching
dark colored urine
acholic feces

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16
Q

acholic feces

A

malodorous, gray to light colored stool

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17
Q

unconjugated hyperbilirubinemia

A 
hemolysis
RBC defect
ineffective erythropoiesis
deficient hepatic uptake
deficient hepatic conjugation
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18
Q

conjugated hyperbilirubinemia

A

impaired bilirubin excretion

serum alk phos elevated out of proportion to transaminases

intrahepatic - liver disease, drugs, sepsis, biliary cirrhosis

extrahepatic - gallstones, sclerosing cholangitis, parasites, pancreatic cancer, pancreatitis

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19
Q

painless jaundice

A

pancreatic cancer unless proven otherwise

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20
Q

ascites

A

accumulation of peritoneal fluid

most common - cirrhosis of liver - portal HTN

also lymph obstruction, hypoalbuminemia, peritonitis

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21
Q

bulging flank, tympany of abdomen, fluid wave, shift dullness

A

four signs of free fluid in abdomen

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22
Q

DDx for ascites

A 
cirrhosis**
malignancy
CHF
tuberculosis peritonitis
dialysis
nephrotic syndrome
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23
Q

percussion of fluid in abdomen

A

dullness

normal abdomen - tympany

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24
Q

exposure of abdomen

A

xiphoid to pubis

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25
Q

caput medusa

A

portal HTN

26
Q

auscultation of abdomen

A

before palpation
all 4 quadrants
RLQ - best to listen

normal - high pitched tinkle every 3-5 seconds

no bowel sounds 2 minutes - absent

27
Q

borborygmi

A

hyperactive sounds

low pitched rumbling

hyperperistalsis

28
Q

abdominal bruits

A

aortic
renal - lateral to aorta
femoral - inguinal ligament

29
Q

liver percussion

A

dull

30
Q

lung percussion

A

resonant

31
Q

normal liver size

A

10cm

32
Q

percussion of liver

A

right MCL

33
Q

rebound tenderness

A

peritonitis

34
Q

rovsings

A

referred rebound tenderness

35
Q

DDx for peritonitis

A

bacterial - spontaneuous or secondary (appendicitis, diverticulitis, perforated PUD, cholecystitis)

pancreatic ascites
PID
ectopic pregnancy
fitz-hugh-curtis syndrome

36
Q

palpation of liver

A

left hand under right 11th and 12th rib

or hooking method

37
Q

DDx for hepatomegaly

A 
hepatitis
fatty liver
cirrhosis
CHF
cancer
leukemia/lymphoma
38
Q

liver function test

A

enzymes

  • ALT, AST, alk phos
  • tissue damage or obstruction

bilirubin, albumin, PT - function of liver

39
Q

generalized edema

A

anasarca

40
Q

alk phos much larger than AST and ALT

A

extrahepatic problem

41
Q

AST and ALT elevated much larger than alk phos

A

hepatic problem

42
Q

DDx for splenomegaly

A

infection
EBV, CMV, HIV, malaria

EMH
CHF
polycythemia vera
SLE
RA - feltys
metastatic disease
amyloidosis
43
Q

DDx for CVA tenderness

A

nephrolithiasis
pyelonephritis

renal cell cancer
DJD - arthritis
pneumonia

44
Q

lloyds sign

A

CVA tenderness

45
Q

DRE

A

get 360 degrees around

also check prostate

46
Q

condyloma acuminata

A

HPV

anal warts

47
Q

condyloma lata

A

syphilis

looks like anal warts

lots of spirochetes

48
Q

procidentia

A

complete rectal prolapse

49
Q

pain periumbilical then to RLQ

A

appendicitis

nausea and vomiting, anorexia**, fever

50
Q

psoas sign

A

psoas muscle inflammation

51
Q

obturator sign

A

right leg figure 4

52
Q

appendicitis work up

A 
CBC
urine
xray
ultrasound
CT - best**
female - pregnancy test
BMP
53
Q

female, fat, fertile, fair, flatulent

A

gallbladder disease

54
Q

RUQ pain, fever, leukocytitis

A

diagnostic triad for acute cholecystitis

55
Q

murphys sign

A

RUQ pain and arrest of inspiration when palpate liver and gallbladder

56
Q

alcohol abuse

A

most common cause of pancreatitis

obstruction
drugs, meds
infection

57
Q

pain radiates to back and constant

A

pancreatitis

58
Q

turners sign

A

discoloration of flanks

59
Q

cullens sign

A

discoloration around umbilicus

60
Q

turners and cullens positive

A

hemorrhagic pancreatitis

PCM III (17 decks)

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